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| CASE REPORT |
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| Year : 2013 | Volume
: 1
| Issue : 1 | Page : 52-53 |
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Kissing molars: An unusual unexpected impaction
Parveen Shahista, Rohan Mascarenhas, Sandeep Shetty, Akhter Husain
Department of Orthodontics and Dentofacial Orthopedics, Yenepoya University, Mangalore, Karnataka, India
| Date of Web Publication | 21-Jun-2013 |
Correspondence Address:
Rohan Mascarenhas
Department of Orthodontics and Dentofacial Orthopedics, Yenepoya University, Mangalore-575 018, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2321-4848.113570
Impacted molars have been widely reported. However, kissing molars is a rare finding which refers to impacted molars which have occlusal surfaces contacting each other in a single follicular space and roots pointing in opposite directions as reported in this case. This is the second case of kissing molars involving third and fourth molar and the only case fulfilling the criteria of kissing molars. Keywords: Distomolar, impactions, kissing molars, mucopolysaccharoidosis
How to cite this article:
Shahista P, Mascarenhas R, Shetty S, Husain A. Kissing molars: An unusual unexpected impaction. Arch Med Health Sci 2013;1:52-3 |
| Introduction | |  |
Impacted tooth is one that fails to erupt and will not eventually assume its anatomical arch relationship beyond the chronological eruption date. This may be caused by a physical barrier or ectopic positioning of a tooth.
Impaction may be classified according to the angulation of the tooth to the remaining dentition and may be termed as mesioangular, distoangular, vertical, horizontal or inverted. Occasionally, interesting patterns of impacted teeth are seen such as 'Kissing Molars,' in which the occlusal surfaces of the molars are in close contact with each other.
| Case Report | | |
A 21-years-old female patient reported to the department of orthodontics and dentofacial orthopedics of our university hospital with a chief complaint of irregular arrangement of teeth.
Clinical examination revealed incompetent lips, proclined upper anteriors, and moderate crowding in both the arches. All third molars and maxillary left permanent canine were missing, and maxillary left deciduous canine was over retained.
The panoramic radiograph confirmed the presence of all the third molars, which were impacted. It also revealed the presence of fourth molar in the third quadrant, which shared the same follicular space of the mandibular left third molar [Figure 1] and [Figure 2]. The occlusal surfaces of the two teeth were in contact with each other. The radiograph also showed that the left maxillary canine was impacted, and it was decided to bring it to occlusion orthodontically.  | Figure 1: Panoramic X-ray showing Kissing Molars (third and fourth molars in single follicular space) in the lower left quadrant
Click here to view |
| Discussion | | |
Impaction of teeth is a commonly occurring condition. Third molars are the most frequently impacted teeth. The occurrence of fourth molar or distomolar is rare. Gay et al,(1999) have reported a low prevalence between 0.13% and 0.6% for fourth molars. [1] When the occlusal surface of the two impacted molars are opposing each other in a single follicular space, it is known as "Kissing Molars," and it was first reported by R.F. Van Hoof [2] in the year 1973. A thorough survey of literature reveals very few reported cases of kissing molars. [2],[3],[5],[6],[7],[8] Most of the reported cases of kissing molars involved second and third molars except one case reported by Ghazi Bhakeem. [6] It is our observation in all the reported cases of "Kissing Molars," none of the occlusal surfaces are exactly opposing each other. Multiple impacted teeth are also seen in various syndromes of head and neck. As the abnormality, here was a solitary feature and it was not associated with any other syndromes. [4] Although the lower third and fourth molars were positioned in a single follicular space, with their crowns in close apposition and roots diverging, the follicular space was not enlarged. This indicated absence of pathology, and it was decided to remove them surgically later.
The term 'Kissing Molars' as described by Van Hoof [2] refers to teeth, which have occlusal surfaces contacting each other in a single follicular space and roots pointing in opposite directions. None of the earlier reported cases fulfilled criteria as described by Van Hoof. This is the only case where the crowns of the third and fourth molars were exactly opposing each other and fulfils the description of the 'Kissing Molars.'
| Conclusion | | |
Even though impaction of teeth is a common finding in jaws, "Kissing Molars" have rarely been reported. Systemic evaluation and clinical co-relation will also be necessary because, sometimes, multiple impactions are also associated with systemic diseases. Early detection of this may help in diagnosis of any underlying systemic conditions. Although cases of "Kissing Molars" were reported earlier, this is the only case exhibiting all the classical features and involving third and fourth molars.
| References | | |
| 1. | Fuentes R, Borie E, Beltrán V. Radiographical and macroscopical visualization of fourth molars: A report of four cases in maxilla. Int J Morphol 2012;30:115-8. 
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| 2. | Van Hoof RF. Four Kissing molars. Oral Surg Oral Med Oral Pathol 1973;35:284.
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| 3. | Robinson JA, Gaffney W, Soni NN. Bilateral Kissing molars. Oral Surg Oral Med Oral Pathol 1991;72:760.
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| 4. | Nakamura T, Miwa K, Kanda S. Rosette formation of impacted molar teeth in mucopolysaccharidoses and related disorders. Dentomaxillofac Radiol 1992;21:45-9.
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| 5. | McIntyre G. Kissing Molars: an unexpected finding. Dent Update 1997;24:373-4.
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| 6. | Bakaeen G, Baqain ZH. Interesting Case: Kissing Molars. Br J Oral Maxillofac Surg 2005;43:534.
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| 7. | Krishnan B. Kissing molars. Br Dent J 2008;204:281-2.
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| 8. | Buffano P, Gallesio C. Kissing Molars. J Craniofac Surg 2009;20:1269-70.
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[Figure 1], [Figure 2]
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